Healthcare Provider Details

I. General information

NPI: 1851190953
Provider Name (Legal Business Name): DAVID JAMES SHAVER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4458 JONESBORO RD
FOREST PARK GA
30297-4314
US

IV. Provider business mailing address

299 N HIGHLAND AVE NE UNIT 4040
ATLANTA GA
30307-5643
US

V. Phone/Fax

Practice location:
  • Phone: 470-878-3512
  • Fax:
Mailing address:
  • Phone: 404-452-1811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN123834
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: